Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05963 | Date 27/05/2022 |
| Token No | SM/22-23/3159 27/05/2022 | Serial | 023 |
| Patient Name | Miss NABANITA SHAW | Contact No | NOT GIVEN |
| Address | 11 NO LINE | Age | 22 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||